could Advil be the culprit (bloody stool)?

I think you'd have to be awfully unlucky to get this reaction from one dose of Advil, unless you're allergic to it. Most of the problems with Advil occur with more extended use. Did anything else change? Have you ever had an episode like this before?

Ordinarily, I'd be surprised by a bleeding episode after a single dose of ibuprofen. However, if you are sensitive to it, a large dose, such as you took (800mg) could definitely be the cause. That dose is a prescription only dose and should only be taken on the advice of your doctor.

You may be able to tolerate lower doses, but be ready to discontinue it immediately if you have trouble again. 

I was able to tolerate high doses without bleeding for years, but I eventually had to stop due to liver inflammation. It is very individual.

Jan

I had taken two regular strength Advil the day before also.  I know once I took Aleve when I had colitis and it brought on what I thought was an all out flare. I have quit taking it ...am registered to run a half marathon (first race in 4 years!) but if I'm bleeding I won't run. I'm hoping it'll settle by morning.

Now that I'm thinking about it, I've also been using Voltarin cream which is a topical nsaid. I could be getting some of it systemically. Maybe a combination of the three could account for a reaction?

Quite possible. Perfect storm...

400mg ibuprofen might have been fine, but 800mg could be over the top.

Jan

Up to 10% of topical Voltaren can be absorbed systemically. It generally shouldn't be combined with oral NSAIDs, especially large doses.

I can't use NSAIDS at all because they will make me bleed. It happened the first time when I used Motrin for migraines. Months later, I tried using only one Excedrin on each of  two successive days and had bleeding. It was a weekend, so I called the nurse advice line, who called the on-call doctor. He was sure this was from the Excedrin, which is also an NSAID, as is aspirin. Now I know, but then I didn't. They didn't prescribe any meds. They said to stay on a soft diet for a week. That did the trick and I was fine. 

Rose

Thanks for these replies. Live and learn...I won't chance it with nsaids again. It sure worked for the achilles problem though and I don't know of an alternative for reducing inflammation like that. 

One more little piece to this...

I was very surprised that such a small quantity of NSAIDS could cause bleeding, but was convinced when I took no more NSAIDS and after several hours elapsed, there was no more blood. On top of this, the on-call G.I. specialist was absolutely certain that NSAIDS caused the bleeding, which tells me that he has seen quite a bit of this in his practice or has read peer-reviewed articles about this possibility. The nurse also mentioned that intestinal/pouch lining is very delicate and that if any part of it is irritated, rough food (even ground meat in a hamburger, which I consider soft but the nurse said was too rough) would continue to irritate it. Thus the reason for soft foods for a week till it healed. 

Rose

Achilles tendinitis was one of the problems I had that was eventually linked to enteropathic arthritis. When I could not take NSAIDs any longer, I was sent to a podiatrist who used PT,  CAM walker boot, and a course of prednisone. I also now need lifts in my shoes or a 2 inch heels to prevent pain. I have permanent calcification of both Achilles tendons now. So, I am careful, stretch and be sure to warm up well. 

A few years later my sacroiliitis pain started and I was sent to a rheumatologist, who connected the dots and told me that it was all one disease, enteropathic arthritis, one of the spondyloarthropathies.

Hopefully, yours is just injury related.

Jan

I hadn't thought of this as anything other than a running injury. It came on quite suddenly and in both tendons. Jan, was your Achilles tendinitis a fairly sudden onset? Also I'm wondering if NSAIDS with protein pump inhibitor would make a difference. I can barely walk right now. 

(By the way, the bleeding has stopped)

Yes, it was sudden. I was not a runner, but would go on daily walks. Even with proton pump inhibitors, your bleeding risks in the pouch and rectal cuff would remain. The PPI would mostly protect the stomach and duodenum.

I do still use NSAIDs when I have a flare, but limit it to a couple of weeks and do not use ibuprofen (one of the worst for GI complications). You could try meloxicam or Celebrex and see if you can tolerate them. Of course, acetominophen or opiates are OK too, but they are not anti-inflammatory. Worst case scenario, a short course of prednisone with a fast taper might help.

You probably do not have enteropathic arthritis, but just keep it in mind if this becomes chronic or you develop other tendinopathies and sacroiliitis. This link shows commonly affected areas:

http://www.spondylitis.org/about/complications.aspx#

Jan

This happened to me.  I was trying to run a small business and standing all day and at night I took pain meds.  I forgot which brand, but I ended up with a bleed bad.  I went to the e.r. it scared me because that never happened before.  They put me on celebrex but then I had another bleed and then a blockage.  No pain meds now for me.  I just try and deal with the everyday fibro pain now and arthritis isn't too bad (not yet).  Be careful of pain meds.  Dr. Shen in Cleveland Clinic just told me I probably didn't do myself any favors because I took pain meds in different forms for so many years.  He said pain meds are one of the worse meds for a j pouch.  

Not ALL pain meds are potentially bad for the pouch, just NSAIDs.

Jan